A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery?

Choice A reason: This is incorrect because NPH insulin is normally cloudy and should be gently mixed before use. However, the nurse should discard the solution if it has clumps, flakes, or crystals.

Choice B reason: This is correct because NPH insulin is an intermediate-acting insulin that has a slower onset and longer duration than short-acting or rapid-acting insulins. The nurse should explain to the client that NPH insulin provides basal coverage and may need to be combined with other types of insulin to control blood glucose levels.

Choice C reason: This is incorrect because freezing insulin can damage its potency and effectiveness. The nurse should instruct the client to store unopened insulin vials in the refrigerator and opened vials at room temperature.

Choice D reason: This is incorrect because shaking insulin can cause air bubbles and frothing, which can affect the accuracy of the dose. The nurse should instruct the client to roll the insulin vial between the palms of the hands to mix it gently.

The correct answer is c. 2,525 mL.

Choice A reason:

1,350 mL is calculated by considering only the lactated Ringer’s IV intake. The calculation is as follows:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL. This option does not include the intake from cefazolin, packed RBCs, sodium chloride boluses, or famotidine.

Choice B reason:

1,600 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.

Choice C reason:

2,525 mL is the correct total intake. The detailed calculation is:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL.
• Cefazolin in 100 mL of 0.9% sodium chloride: 100 mL.
• Two units of packed RBCs: 275 mL + 250 mL = 525 mL.
• Two IV bolus infusions of 250 mL of 6.0% sodium chloride: 250 mL + 250 mL = 500 mL.
• Famotidine in 50 mL of 0.9% sodium chloride: 50 mL.

Adding these together: 1,350 mL + 100 mL + 525 mL + 500 mL + 50 mL = 2,525 mL.

Choice D reason:

2,100 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.